Open Payments (Sunshine Act): How Industry Payments to Clinicians Are Reported

What Open Payments is

Open Payments was created by Section 6002 of the Affordable Care Act, a provision often called the Physician Payments Sunshine Act, which added section 1128G to the Social Security Act. CMS runs it as a national disclosure program; its Open Payments page explains the program, the yearly timeline and how to search the data.

The reporting rules are in federal regulations at 42 CFR Part 403, Subpart I. The definitions section says who must report and who is a covered recipient, and the section on reports of payments and other transfers of value sets out what companies must report and which details each record contains.

Who reports

Two kinds of companies report:

• Applicable manufacturers: companies that make drugs, devices, biologicals or medical supplies covered by Medicare, Medicaid or the Children's Health Insurance Program.
• Applicable group purchasing organizations (GPOs): organizations that buy, arrange for or negotiate the purchase of those products.

Whose payments are reported

The people and institutions receiving payments are called covered recipients. Under the regulation they are physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and certified nurse-midwives, plus teaching hospitals. The CMS Open Payments glossary notes that the program expanded in January 2021 to include five new provider types beyond physicians; CMS also counts anesthesiologist assistants in that group.

What gets reported

CMS's Open Payments data page groups the records into three categories:

1. General payments: payments or other transfers of value not made for research. Examples include consulting fees, speaker fees, honoraria, food and beverage, travel and lodging, education and royalties.
2. Research payments: payments tied to a research agreement or research protocol, such as a clinical trial.
3. Ownership and investment interests: ownership or investment interests that physicians, or their immediate family members, hold in a manufacturer or GPO. CMS notes that this category does not apply to the other clinician types or to teaching hospitals.

Each record includes the company, the amount, the date, the form of payment (for example cash or in-kind items) and the nature of the payment (for example "Food and Beverage" or "Consulting Fee"). Many records also name the drug or device the payment was related to.

Small payments

Very small transfers of value are excluded from reporting unless the yearly total to the same recipient passes a threshold. The regulation starts from payments of less than $10, unless the yearly total exceeds $100, and raises both amounts each year in line with the consumer price index, so the current thresholds are higher.

How the data is published and corrected

Companies submit data for each program year, which covers payments made from January 1 to December 31. CMS publishes the data annually on or by June 30 of the following year, and its data page explains that the published data is refreshed in January of each year to include later corrections.

Before publication, covered recipients get a review period. The CMS review and dispute page explains the yearly cycle:

• April 1 to May 15: a 45-day pre-publication period in which registered clinicians and teaching hospitals can review the records attributed to them and dispute any they believe are wrong.
• May 15 to 30: reporting companies can correct disputed records before they become public.
• Until December 31: covered recipients can still dispute records; corrections received after May 15 are published in the January refresh.

Review and dispute is voluntary, but CMS strongly encourages covered recipients to do it.

Because of this cycle, a clinician's records for a year can change after first publication, and the newest data is always for a year that has already ended.

How to look up a clinician

CMS provides a free Open Payments search tool. You can search by clinician name, teaching hospital or company, and filter by program year. Each record shows the company, amount, date and nature of payment.

When you search, check that the record matches the right person. Names repeat, so compare the city, state and specialty shown in the record.

Reading the data carefully

CMS's Open Payments overview puts it simply: just because financial ties are reported in Open Payments does not mean anyone has done anything wrong. CMS also does not comment on which relationships may be beneficial or potential conflicts of interest. Keep these points in mind:

• Payments cover many kinds of activity. A meal at an educational event, a fee for teaching other clinicians and funding for a clinical trial can all appear in the data.
• Research payments are different from general payments. A research record can name a clinician as a principal investigator of a study even when the payment went to the institution running it.
• Amounts are what companies reported. A disputed or mistaken record may still appear until it is corrected.
• No record does not mean no relationship, and a large total does not by itself mean a clinician's care is influenced.

Talking to your clinician

If a payment matters to you, for example when a doctor recommends a device made by a company that paid them, it is reasonable to ask about it. You might ask how they choose between treatment options and whether other options would work for you. Many clinicians are used to this question.

What T-MedInfo shows

Clinician profiles on this site include an Open Payments section when CMS data lists payments to that clinician. For each program year we show the number of records and the total amount, and you can open the records with the company name, date, amount and nature of payment.

Next to the data we show the program year's dates and, where our import succeeded, the date CMS released that version of the data. We repeat the CMS statement that a reported payment does not necessarily mean the financial relationship is improper, and we link to the CMS review and dispute process for clinicians.

Totals on city and state pages add up the payments for clinicians in that area for the program years we have loaded. They describe reported payments, not income, and they come straight from the CMS records we imported.

If a record is wrong, the correction has to happen at CMS through the dispute process. Once CMS publishes the corrected data, our next import picks it up.